Mammographic localization and biopsy of nonpalpable breast lesions. A 5-year study.

A malignancy rate of 24% was achieved as a result of needle localizations and biopsies of 548 nonpalpable mammographically detected breast lesions in 507 consecutive patients during a 5-year period. Malignancy was present in 74 (23.8%) of 311 irregular soft-tissue densities, in 40 (19.6%) of 204 cases with clustered microcalcifications, and in 33 cases (54.5%) when both features were present. Same-day admission and discharge were achieved in 491 patients and local anesthesia supplemented with intravenous sedation was used in 73 (74%) of the 98 patients (in 1989) by the end of the study period. Nonpalpable cancers were categorized pathologically as stage 0 in 25 patients (20.8%), stage I in 67 patients (55.8%), stage IIA in 24 patients (20.0%), and stage IIB in four patients (3.3%). The malignancy rate rose sharply from the fourth to the fifth decade.

Experience with the EEA stapling device.

The EEA stapling instrument was used to perform 48 anastomoses without operative mortality. One of the 29 colorectal anastomoses developed a leak. Two intraabdominal abscesses were noted, one after an intraperitoneal colocolostomy and one after a colorectal anastomosis. No leaks were demonstrated in the 12 esophageal anastomoses. Minor bleeding that occurred in one of the colorectal anastomoses ceased spontaneously without need for transfusion. One esophageal and one colorectal anastomosis became narrowed postoperatively, but both were corrected with dilatation without further problem. In two of the very low colorectal anastomoses, transient fecal soilage occurred for 4 to 5 months postoperatively. On the basis of our experience, we believe that the EEA instruments has a definite place in gastrointestinal surgery. Its greatest virtue is that it provides a means to perform the heretofore technically difficult and frequently insecure colorectal and esophageal anastomoses with greater facility and security.

Change in the management of adult groin hernia.

Three hundred fifty-seven groin hernia repairs were performed under local anesthesia using a long-lasting local anesthetic agent. An ilioinguinal, iliohypogastric, and twelfth intercostal nerve block was carried out initially, followed by regional infiltration of the agent, using a technic first described by Ponka [8] with several modifications. This technic can be employed suffessfully in the majority of groin hernia repairs. It requires careful attention to detail in the administration of preoperative sedation and analgesia and the use of sharp dissection only and greater gentleness in the handling of tissue. We have observed a significant reduction in postoperative discomfort and the virtual elimination of urinary retention, urinary sepsis, atelectasis, and phlebitis in these cases. All patients are fully ambulatory, without assistance immediately after surgery and the majority are discharged the same day or the following morning. This results in a marked reduction in the total cost of repairing a groin hernia.